Implant based differences in adverse local tissue reaction in failed total hip arthroplasties: a morphological and immunohistochemical study

BMC Clinical Pathology

P Edward Purdue¹  Steven R Goldring¹  Dan Maass¹  Gabrielle Wilner¹  Guido Martignoni³  Seth A Jerabek⁴  Benjamin F Ricciardi⁴  Giorgio Perino² 

[1] Division of Research, Hospital for Special Surgery, New York, NY, USA;Department of Pathology, Hospital for Special Surgery, 535 East 70th Street, New York NY 10021, USA;Department of Pathology and Diagnostics, University of Verona, Verona and Pederzoli Hospital, Peschiera, Italy;Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA

关键词: Synovial inflammation;    Revision arthroplasty;    Corrosion products;    Adverse local tissue reaction;   

Others  :  1084488
DOI  :  10.1186/1472-6890-14-39

 received in 2014-05-13, accepted in 2014-09-01,  发布年份 2014

【 摘 要 】

Background

Adverse local tissue reaction (ALTR) is characterized by periprosthetic soft tissue inflammation composed of a mixed inflammatory cell infiltrate, extensive soft tissue necrosis, and vascular changes. Multiple hip implant classes have been reported to result in ALTR, and clinical differences may represent variation in the soft tissue response at the cellular and tissue levels. The purpose of this study was to describe similarities and differences in periprosthetic tissue structure, organization, and cellular composition by conventional histology and immunohistochemistry in ALTR resulting from two common total hip arthroplasty (THA) implant classes.

Methods

Consecutive patients presenting with ALTR from two major hip implant classes (N = 54 patients with Dual-Modular Neck implant; N = 14 patients with Metal-on-Metal implant) were identified from our prospective Osteolysis Tissue Database and Repository. Clinical characteristics including age, sex, BMI, length of implantation, and serum metal ion levels were recorded. Retrieved synovial tissue morphology was graded using light microscopy and cellular composition was assessed using immunohistochemistry.

Results

Length of implantation was shorter in the DMN group versus MoM THA group (21.3 [8.4] months versus 43.6 [13.8] months respectively; p < 0.005) suggesting differences in implant performance. Morphologic examination revealed a common spectrum of neo-synovial proliferation and necrosis in both groups. Macrophages were more commonly present in diffuse sheets (Grade 3) in the MoM relative to DMN group (p = 0.016). Perivascular lymphocytes with germinal centers (Grade 4) were more common in the DMN group, which trended towards significance (p = 0.066). Qualitative differences in corrosion product morphology were seen between the two groups. Immunohistochemistry showed features of a CD4 and GATA-3 rich lymphocyte reaction in both implants, with increased ratios of perivascular T-cell relative to B-cell markers in the DMN relative to the MoM group (p = 0.032).

Conclusion

Our results demonstrate that both implant classes display common features of neo-synovial proliferation and necrosis with a CD4 and GATA-3 rich inflammatory infiltrate. Qualitative differences in corrosion product appearance, macrophage morphology, and lymphocyte distributions were seen between the two implant types. Our data suggests that ALTR represents a histological spectrum with implant-based features.

【 授权许可】

   
2014 Perino et al.; licensee BioMed Central Ltd.

【 图 表 】

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